Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Wednesday, October 22, 2008

Signature projects for 2009

As we approach 2009 there are 10 projects that I consider high risk and high gain. I call them my "signature" projects. These projects have the potential to radically transform the way we work at Harvard, CareGroup, and throughout Massachusetts. Although many are nascent ideas and have been assigned to my most senior direct reports with the notion that they have partially defined scope and vision, I am committing my time and reputation to their success:

1. High Performance Computing for the Northeast - By creating a large, community-based 3000 CPU core resource with flexible federated storage options and software licensed at low cost via economies of scale, we can accelerate collaboration among Harvard schools, Boston University, Northeastern, and the numerous industry-based researchers in our region. We've kicked off the project and are now assembling a governance committee to guide the effort.

2. Social Networking for research - By bringing together the community to identify collaborators, mentors, and resources via social networking, we can accelerate innovation. We've launched Catalyst Profiles but now need to enhance it with novel tools that provide additional value to stakeholders such as an eBay like marketplace for exchange of tools, talent and technologies among our faculty. Our success will be measured by the number of users embracing our social networking tools.

3. A hosting center for Electronic Health Records supporting all the doctors in our community - We're already live with our first sites and our success will be measured by our ability to implement electronic health records for every member of the BIDMC community by the end of 2010.

4. A suite of healthcare information exchange solutions - It's clear to me that Healthcare Information Exchange is not a one size fits all project. We've had success in Massachusetts by creating centralized repositories for cities (Newburyport, Brockton, North Adams) and also creating secure peer to peer summary exchange via the internet. We're working on a suite of solutions in 2009 including linking together all private practices within a physician's organization, linking together hospitals, and linking together cities. Each of these solutions requires a different set of tools and a different balance of central/local data stores.

5. Eliminating paper with automated clinical documentation - Although BIDMC is largely electronic in all ambulatory areas, inpatient progress notes are still handwritten. Our goal is to be 85% electronic throughout the hospital by 2010.

6. Supporting virtual teams and flexible work arrangements - As the economy slows, commuting and travel expenses become more painful. Also, there is pressure to reduce the overhead costs of space, parking and utilities. Flexible work arrangements and virtual teams can enhance productivity, reduce costs, and increase employee satisfaction. Thus I will continue rollout infrastructure and policies supporting virtual teams in 2009. The metric for success is the number of mobile workers we support.

7. Implementing iPod Touch/iPhone 3G and Amazon Kindle applications for enhanced mobile computing - Clinicians are mobile knowledge workers and their productivity depends upon being connected to the applications they need regardless of their location. Although we're already supporting Blackberry, iPhone and wireless connectivity to our applications, I hope to enhance our mobile application support, likely through an initial pilot of an iPhone compatible Emergency Department workflow tool.

8. Deploy a suite of web-based tools which support business process automation - 2009 is all about workflow. Rather than deploy a variety of niche applications supporting administrative needs at Harvard Medical School, I'd rather implement an integrated set of collaboration tools which support the workflow of committee meetings, faculty selection processes, record keeping, and information sharing. I'm working on a requirements analysis for this suite of tools over the next 60 days.

9. Create a cloud of life cycle managed storage for enterprise image management - At Beth Israel Deaconess Medical Center and Harvard Medical School, the demand for tiered storage - fast/high availability/expensive, medium performance/mostly available/$1 per gigabyte and low performance/less available/really cheap storage continues to escalate. Over the next 6 months, we'll study many products from many vendors so that we can offer storage solutions approaching a pedabyte at a cost the community can afford.

10. Working with HITSP to embrace a Service Oriented Architecture approach to interoperability - Over the past three years, the Health Information Technology Standards Panel (HITSP) has worked on content/vocabulary and transport standards for electronic health data. In 2009, we'll work on transaction orchestration standards. HITSP has formed a working group to evaluate the value of embracing a Services Oriented Architecture (SOA) for all HITSP interoperability specifications. If this moves forward, HITSP standards are likely to become plug and play, enhancing the interoperability of healthcare data between organizations.

These 10 signature projects are where I'll spend most of my time in 2009, managing change, politics, and innovation at BIDMC, Harvard, MA-Share/NEHEN and HITSP.